A comparative study of surgical repair of large atrial septal defects in adults using inferior mini-sternotomy and right axillary vertical mini-incision

Limited-access surgical repair remains important for adults with large atrial septal defects (ASDs) when transcatheter closure is unsuitable. This research aimed to compare early outcomes of inferior mini-sternotomy and right axillary vertical mini-incision for large ASD repair under cardiopulmonary bypass (CPB) without aortic cross-clamping. This retrospective study included 79 adults from January 2020 to January 2024. Based on surgical approaches, patients were divided into Group A ( n = 40, inferior mini-sternotomy) and Group B ( n = 39, right axillary vertical mini-incision). Operative variables, postoperative recovery, pain scores, complications, costs, and 3-month follow-up findings were compared. All patients underwent successful repair without perioperative death, conversion, reoperation, major residual shunt, stroke, or low-output syndrome. Operative time, CPB duration, transfusion volume, duration of tracheal intubation, ICU stay, postoperative hospital stay, hospitalization cost, and myocardial injury markers were comparable between groups. Group B had higher pain scores on postoperative days 2 and 3 ( P < 0.05). Pulmonary infection, pneumothorax, pleural effusion, and phrenic nerve palsy occurred only in Group B, whereas superficial wound infection, sternal malunion, and hypertrophic scar or keloid occurred only in Group A; most complication differences were not statistically significant. During 3-month follow-up, no death, reoperation, major residual shunt, cerebrovascular event, or severe rhythm-related event was observed. Both approaches enabled safe early large ASD repair on-pump CPB without aortic cross-clamping. Right axillary vertical mini-incision offered better scar concealment but greater early pain and pulmonary-management demands.